436 Chapter 12 Approaches to Treatment and Therapy
treatment for trauma victims” (Mayou, Ehlers, &
Hobbs, 2000). The World Health Organization,
which deals with survivors of trauma around the
world, has officially endorsed this conclusion (van
Ommeren, Saxena, & Saraceno, 2005).
You can see, then, why the scientific assess-
ment of psychotherapeutic claims and methods is
important.
Watch the Video Thinking Like a Psychologist:
Assessing Treatment Effectiveness at MyPsychLabWhen Therapy Helps LO 12.11
We turn now to the evidence on which therapies
are most effective (e.g., Chambless & Ollendick,
2001). For many specific problems and most emo-
tional disorders, cognitive and behavior therapies
have emerged as the methods of choice:• Depression. Cognitive therapy’s greatest success
has been in the treatment of mood disorders,
especially depression (Beck, 2005), and people
in cognitive therapy are less likely than those
on drugs to relapse when the treatment is
over. The lessons learned in cognitive therapy
last a long time after treatment, according to
follow-ups done from 15 months to many years
later (Hayes et al., 2004; Hollon, Thase, &
Markowitz, 2002; Seligman et al., 1999).
• Suicide attempts. In a randomized controlled study
of 120 adults who had attempted suicide and had
been sent to an emergency room, those who were
given 10 sessions of cognitive therapy were only
about half as likely to attempt suicide again in theDebriefing (CISD), survivors gather in a group
for “debriefing,” which generally lasts from one to
three hours. Participants are expected to disclose
their thoughts and emotions about the traumatic
experience, and the group leader warns members
about traumatic symptoms that might develop.
Yet randomized controlled studies with people
who have been through terrible experiences—
including burns, accidents, miscarriages, violent
crimes, and combat—find that posttraumatic
interventions, especially those that require people
to focus on their emotions and express them fre-
quently, can actually delay recovery in some people
(van Emmerik et al., 2002; McNally, Bryant, &
Ehlers, 2003). In one study, victims of serious car
accidents were followed for three years; some had
received CISD and some had not. As you can see
in Figure 12.1, almost everyone had recovered in
only four months and remained fine after three
years. The researchers then divided the survivors
into two groups: those who had had a highly emo-
tional reaction to the accident at the outset (“high
scorers”), and those who had not. For the latter
group, the intervention made no difference; they
improved quickly anyway (Mayou et al., 2000).
Now, however, look at what happened to the
people who had been the most traumatized by the
accident: If they did not get CISD, they were fine
in four months, too, like most of the others. But for
those who did get the intervention, CISD actually
blocked improvement, and they had higher stress
symptoms than all the others in the study even
after three years. The researchers concluded that
“psychological debriefing is ineffective and has
adverse long-term effects. It is not an appropriateIntervention, high scorersBaseline 4 months 3 yearsImpact of event scale
101520253035400AssessmentNo intervention, high scorersIntervention, low scorers
No intervention, low scorersFigURE 12.1 Do Posttraumatic interventions Help or Harm?
Victims of serious car accidents were assessed at the time of the event, four months later, and three years later. Half
received a form of posttraumatic intervention called Critical Incident Stress Debriefing; half received no treatment.
As you can see, most people had recovered within four months, but one group continued to have a lot of stress symp-
toms even after three years: the people who were the most emotionally distressed right after the accident and who
had received CISD. The intervention actually impeded their recovery (Mayou et al., 2000).